Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Abstract

Background: Maximizing patient and allograft survival after liver transplant (LT) is important from both a patient care and organ utilization perspective. Although individual studies have addressed the effects of short-term post-LT complications on a limited scale, there has not been a systematic review of the literature formally assessing the potential effects of early complications on long-term outcomes.Objectives: To identify whether short-term complications after LT affect allograft and overall survival, to identify short-term complications of particular clinical interest and significance, and to provide recommendations to improve post-LT graft and patient survival.Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.Methods: A systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Results:The literature review and analysis provided show that short-term complications have a large impact on allograft and patient survival after LT. The complications with the strongest effect on survival are acute kidney injury (AKI), biliary complications, and early allograft dysfunction (EAD). Conclusion: This panel recommends taking measures to reduce the risk and incidence of short-term complications post-LT. Clinicians should pay particular attention to preventing or ameliorating AKI, biliary complications, and EAD (Quality of evidence; Moderate | Grade of Recommendation; Strong).

Intraoperative Vasoactive Medications and Perioperative Outcomes in Liver Transplantation: A Systematic Review and Network Meta-analyses

“…1,81 Rather, the incidence of complications, quality of recovery, and quality of life should be the targets to improve in perioperative studies conducted in this population. [82][83][84] Despite the limited QoE on important postoperative outcomes, we observed that more potent vasoconstrictors might help reduce intraoperative bleeding, the best QoE we found being on the blood loss reduction effect of terlipressin (moderate QoE). Terlipressin is a potent vasoconstrictor with a specific splanchnic effect, whereas phenylephrine is a potent alpha-1 agonist known to increase venous return to the central circulation.…”

“…1,81 Rather, the incidence of complications, quality of recovery, and quality of life should be the targets to improve in perioperative studies conducted in this population. 82-84…”

Gp78 deficiency in hepatocytes alleviates hepatic ischemia-reperfusion injury via suppressing ACSL4-mediated ferroptosis

“…Liver transplantation (LT) is an established life-saving treatment for end-stage liver diseases and early hepatocellular carcinoma (HCC) [ 1 – 5 ]. During LT, the liver is subjected to ischemia and reperfusion injury (IRI), leading to early allograft dysfunction (EAD) and even primary graft nonfunction (PNF), compromising the survival of grafts and recipients, especially for extended criteria donors [ 6 – 8 ]. Despite great clinical significance, there is no effective treatment for liver IRI yet, and about 25% of LT recipients still develop EAD.…”